| Organization Name: | DVA HEALTHCARE RENAL CARE, INC. |
| NPI Number: | 1013986389 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | THOMAS O USILTON (GROUP VICE PRESIDENT) |
| Mailing Address: | 821 Lincoln Hwy Fairview Heights |
| State: | IL US |
| Postal Code: | 622082216 |
| Phone Number: | 6186329550 |
| Fax Number: | 6186328903 |
| NPI Enumeration Date: | 03/17/2006 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QE0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | End-Stage Renal Disease (ESRD) Treatment |
| Taxonomy Definition: | |